The present invention relates to a technical field of an endoscopic clipping device used for stopping bleeding, suturing or closing a wound, or the like in a living body or the like. More particularly, the present invention relates to a manipulating handle for a successive clipping device which allows a plurality of clips to be used in succession, and a successive clipping device using such a manipulating handle as well as a manipulating handle for a clipping device using a single clip, and a clipping device using such a manipulating handle.
Recently, an endoscopic clipping device is used for causing a clip to protrude from the forward end of an endocope inserted into a living body to pinch a bleeding portion or a portion to be treated after removal of a lesion tissue with the clip, thereby stopping the bleeding, suturing or closing the wound. In a conventionally used endoscopic clip, a single clip is detachably attached to the forward end of a manipulating wire, and each time clipping is effected, the entire sheath is pulled out of the endoscope, and the sheath is loaded with the next clip before being inserted into the endoscope again for the next clipping. In this way, the conventional clipping device involves a rather bothersome operation.
In view of this, JP 2002-272751 A describes a clipping device for a living tissue in which a plurality of clips is arranged in a single sheath. Specifically, there is described a clipping device for a living tissue which includes an introduction tube insertable into a living body cavity, at least two manipulating wires inserted through the introduction tube to be capable of advancing and retreating therein, and at least two clips each having a proximal end portion, and arm portions which extend from the proximal end portion and have pinching portions formed at the forward ends thereof. In the clipping device for a living tissue, the plurality of clips is arranged in series in the introduction tube, and the clips and the manipulating wires are engaged with each other.
Further, JP 2002-272751 A also describes a mechanism as a manipulating portion of the clipping device, which effects clipping by connecting the individual manipulating wires to the individual clips, providing the manipulating portion with knobs connected to the manipulating wires, and individually manipulating the knobs. The knobs are each engaged with a slider provided in the manipulating portion. Further, the slider has a ratchet mechanism which allows the slider to be axially movable with respect to the proximal portion.
By arranging a plurality of clips within a single introduction tube (hereinafter referred to as sheath) as in the clipping device (hereinafter referred to also as clipping device) for a living tissue described in JP 2002-272751 A, it is possible to effect clipping (i.e., clipping manipulation) of a plurality of portions without pulling the entire sheath out of the endoscope.
However, in the clipping device described in JP 2002-272751 A, the wires are attached to the grips on a one-by-one basis to result in an increase in the number of components, which leads to the problem of higher cost of the device, and the problem of a large number of production steps.
In addition, because the amount of sliding of the slider is not restricted, a manipulator (operator) needs to perform an operation of protruding the clip from the forward end of the sheath, while checking the amount of sliding. When the amount of sliding of the slider increases to cause even the forward end of the next clip to protrude, the manipulation of the clip becomes difficult.
Moreover, the knobs are provided correspondingly to the individual clips, and hence the order of manipulations may be mistaken and, when an unintended clip is pulled, the clip or the sheath may be broken.
Thus, due to the complexity of slider manipulation and such manipulation as pulling of the wires with the knobs, the problems of poor manipulating properties, and a high risk of faulty manipulation also arise.
On the other hand, JP 2002-191609 A describes an example of a clipping device capable of being attached, and effecting ligating manipulation only by advancing and retreating a manipulating member. The clipping device has a clip, a presser tube as a clamping ring fitted over the clip to close it, a connection member insertable into the presser tube to be engaged with the clip, a sheath portion capable of accommodating therein the clip and the presser tube, a manipulating wire inserted through the sheath portion to be capable of advancing and retreating therein, and a hook portion provided in at least one of the presser tube and the sheath portion so as to engage the sheath portion with the presser tube when the clip and the presser tube protrude forward of the sheath portion, and inhibit the presser tube from being accommodated again in the sheath portion.
As described in JP 2002-191609 A, by axially inserting and engaging the hook formed at the forward end of the manipulating wire with respect to the connecting member on the proximal-end side of the clip, the clip can be attached to the manipulating wire by merely moving the manipulating wire in a front-rear direction.
However, when the connecting member of the clip and the connected member provided at the forward end of the manipulating wire are attached in a direction orthogonal to the center axes of the sheath and the clip, if the amount of protrusion of the manipulating wire from the forward end of the sheath changes, the problem of difficult attachment of the connecting member and the connected member arises.
As a result, in the case with the manipulating handle described in JP 2002-191609 A, if a slider moves at the attachment of the clip to the manipulating wire, the amount of protrusion of the manipulating wire from the forward end of the sheath changes, i.e., the position of the connecting member at the forward end of the manipulating wire changes. Consequently, the attachment of the clip to the manipulating wire may be difficult, and the shifted position may cause the deformation of the manipulating wire.